How does psoriatic arthritis contribute to fatigue? What steps can be taken to manage and alleviate this debilitating symptom? Explore the causes, impact, and effective strategies for managing psoriatic arthritis-related fatigue.

Understanding Psoriatic Arthritis Fatigue

Psoriatic arthritis is a chronic, inflammatory condition that can have a significant impact on an individual’s quality of life. One of the most common and debilitating symptoms associated with this disease is fatigue. Studies show that up to 80% of people with psoriatic arthritis experience some degree of fatigue, which can be both physically and mentally draining.

Causes of Psoriatic Arthritis Fatigue

The primary driver of fatigue in psoriatic arthritis is the underlying inflammation caused by the disease. When the body’s immune system becomes dysregulated, it produces proteins called cytokines that trigger inflammation in the joints and skin. These inflammatory processes can lead to feelings of exhaustion and lack of energy, even after a good night’s sleep.

Other factors that can contribute to fatigue in psoriatic arthritis include:

• Joint pain and stiffness that can disrupt sleep
• Skin irritation and rashes that cause discomfort
• Comorbid conditions such as fibromyalgia, depression, and anxiety
• Medication side effects
• Deconditioning due to reduced physical activity

Strategies for Managing Psoriatic Arthritis Fatigue

While fatigue can be a challenging symptom to manage, there are several strategies that individuals with psoriatic arthritis can employ to help alleviate the burden of fatigue:

Optimize Nutrition and Exercise

Maintaining a healthy diet rich in lean proteins, whole grains, fruits, and vegetables can provide the body with the necessary fuel to combat fatigue. Regular exercise, such as walking or swimming, can also help improve energy levels, sleep quality, and overall well-being.

Prioritize Sleep and Relaxation

Establishing a consistent sleep routine, avoiding stimulants before bedtime, and incorporating relaxation techniques like warm baths or meditation can help improve sleep quality and reduce the impact of fatigue.

Medication and Treatment Management

Adhering to the prescribed treatment plan, which may include disease-modifying antirheumatic drugs (DMARDs) or biologic medications, can help control inflammation and minimize the fatigue associated with psoriatic arthritis flare-ups. Patients should work closely with their healthcare providers to ensure optimal medication management.

Pacing and Energy Conservation

Recognizing one’s energy limitations and planning activities accordingly can help individuals with psoriatic arthritis conserve their energy and avoid excessive fatigue. This may involve taking regular breaks, delegating tasks, and finding ways to streamline daily routines.

Addressing Comorbid Conditions

Conditions such as fibromyalgia, depression, and anxiety can exacerbate fatigue in individuals with psoriatic arthritis. Seeking appropriate treatment and management for these comorbidities can help alleviate the overall burden of fatigue.

The Importance of Open Communication

Discussing the impact of fatigue with healthcare providers, family members, and employers can help individuals with psoriatic arthritis access the necessary support and resources to effectively manage this debilitating symptom. Open communication can also help dispel misconceptions about fatigue and ensure that the individual’s needs are properly understood and accommodated.

Conclusion

Psoriatic arthritis-related fatigue can have a significant impact on an individual’s quality of life, but with proactive management and a comprehensive approach, individuals can take steps to mitigate the burden of this symptom. By addressing the underlying causes, optimizing lifestyle factors, and communicating effectively with their healthcare team and support network, individuals with psoriatic arthritis can work towards improving their overall energy levels and well-being.

Why It Happens and How to Manage It

Written by WebMD Editorial Contributors

• Can Psoriatic Arthritis Make You Tired?
• Tips to Manage Psoriatic Arthritis Fatigue

Yes. Studies show close to 80% of people with psoriatic arthritis have some degree of fatigue.

When you have this disease, your body makes proteins called cytokines that cause inflammation. They make your joints swell and become painful or stiff.

These proteins may also cause fatigue, although doctors aren’t sure why. When you have a flare, the cytokines set your immune system off. But instead of fighting an infection, your immune system attacks your joints. Maybe the fatigue comes from your body using energy to do this.

The joint pain and skin rashes that can come with this type of arthritis may also keep you from getting a good night’s sleep. If you have trouble falling or staying asleep, talk to your doctor. A medication might help you get better rest.

If you have psoriatic arthritis and need a nap to get through the day, some simple changes can boost your energy and make you feel better.

1. Watch what you eat. Your body needs the right fuel. So opt for lean protein, whole grains, fruits, and vegetables. Avoid sugars or starchy items that give you a short-term lift and then leave you drained.
2. Stay active. Regular exercise like walking or swimming can ease your pain. That’ll help you sleep better. Activity can also boost your energy during the day.
3. Skip caffeine, nicotine, and alcohol before bedtime. You might think smoking a cigarette, sipping hot tea, or having a cocktail will relax you. The truth is, they’ll make it harder for you to fall asleep or stay asleep.
4. Set a solid sleep schedule. Your body prefers a routine at bedtime. Try to hit the sack at the same time each night and wake up at the same time each morning. Alarms on your clock or phone can help you stay on track.
5. Don’t eat for 2 to 3 hours before bedtime. You may not be able to drift off if you’re digesting a heavy meal. Stomach gas can also keep you awake.
6. Relax before bedtime. Take a soothing, warm bath to ease your joint pain and stiffness. Listen to soft music or read a book to take your mind off your daily stress.
7. Make your bedroom for sleep and sex only. Remove the TV, computer, cellphone, and other distractions. Keep the room dark, quiet, and cool.
8. Use comfortable, supportive bedding. If your mattress and pillows aren’t comfy, you might not be able to stay asleep. Your pain may even get worse. Think about getting pillows or buying a new mattress.
9. Figure out your energy boosters. Find ways to perk up when you feel tired during the day. Listen to upbeat music. Step outside into the sunshine. Take a short walk break at work. Or enjoy a good-for-you snack like fruit or nuts.
10. Follow your treatment plan. Take your medications as prescribed to ease inflammation and pain. That should minimize fatigue. Set reminders on your phone so you don’t forget to take them. Don’t be afraid to ask your doctor if a medication could be to blame, but never adjust the dose or stop taking them on your own.
11. Rule out other causes: Conditions that come along with psoriatic arthritis also cause fatigue, like fibromyalgia, depression, anxiety.
12. Pace yourself: Realize your energy may be in short supply and plan out how you’re going to spend what you have during a day or week.
13. Write it down: It can help to keep a journal of what causes your fatigue and when you notice it most. Is it a certain time of day or a response to an emotional situation? Over time, you’ll build a clear picture of how your body responds.

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Why do I feel so tired?

Is it normal to feel fatigued in psoriatic disease?

It is normal to feel tired after exertion, insufficient sleep or at the end of the day; this tiredness is usually relieved by rest or sleep. With fatigue, the symptoms often go beyond normal tiredness and can include decreased or lack of energy with accompanying physical or mental exhaustion. These symptoms usually persist even after a good night’s sleep.

In the UK, 10-20% of the population report being tired for a month or longer, with 1.5% feeling a need to see their GP. The symptoms often include difficulty sleeping; muscle or joint pain; headaches; painful lymph nodes; sore throat; cognitive dysfunction; symptoms made worse by physical or mental exertion; flu-like symptoms; dizziness; nausea; or palpitations.

What causes fatigue?

As described above, inflammation appears to be part of the process of feeling fatigued, but researchers do not know exactly what the link is, or how increased levels of inflammatory substances in the body influence fatigue.

Myths and misconceptions

There are many myths and misconceptions about fatigue. People are sometimes wrongly viewed as being “lazy” by their work colleagues and sometimes by their own family members.

The reason that the person affected by fatigue is unable to carry out basic everyday tasks is the inflammatory process taking place in their body. People often think that caffeine will help wake them up. As caffeine is a stimulant, the effects are short-lived; people often feel more tired once the initial effect wears off. Caffeine is typically found in coffee, tea, cola and energy drinks. Caffeine is also a diuretic, causing dehydration, which will also have a negative effect. In some instances people may resort to the use of alcohol, under the misapprehension that it will relieve the symptoms. However, alcohol is likely to make people drowsier, depressed and can affect sleep, which will also contribute to fatigue.

What can I do?

If you feel tired all the time, tell your healthcare provider, as it is important to rule out any other causes of fatigue. Sometimes you may need to have your medication changed or take tests so that what is happening, can be fully understood.

With or without medical intervention, there are a number of lifestyle changes that may help you feel generally less exhausted.

Dietary advice

• Eat a diet providing at least five servings of fresh fruit or vegetables a day
• Reduce the animal fats in your diet and avoid fatty foods as much as possible
• Eat fresh, home-made foods rather than pre-packaged convenience foods
• Increase your intake of B-group vitamins, needed for the production of energy in the body. These are found in brown rice, wholegrain bread and cereals, oatmeal and oat flakes, pulses, green leafy vegetables, oily fish and poultry
• Aim to eat more oily fish, virgin olive oil or rapeseed oil, nuts and seeds
• If you are unable to increase your intake of fish, consider taking an omega-3 fish oil supplement
• Cut back on saturated spreads and vegetable oils and products which contain them, such as shop bought biscuits and cakes
• Consider taking a vitamin and mineral supplement supplying around 100% of the recommended daily amount for as many nutrients as possible.

For further information, see Psoriatic Lifestyle and Nutrition.

Behavioural changes

• Avoid things that interfere with sleep, such as caffeine, nicotine, excessive alcohol and eating rich, heavy food late at night
• Avoid excess stress
• Aim to lose excess weight.

Put yourself first

• Take some time to rest during the day
• Keep a balance between the demands on you and your energy
• Learn to say no, if possible
• Tell people when you are tired
• Avoid using unnecessary energy.

Physical activity

Some people find it difficult to get motivated and take part in some form of physical activity. As everyone has different activity levels, pain thresholds and body weight, you should start by finding activities which keep you mobile and strengthen your muscles, but which do not cause you any pain. Try to think of a physical activity that you enjoy which you can easily fit into your daily routine. If you enjoy walking, try to go for a walk a few times a week and increase the walking time by a minute or so per session. After a few weeks you will have learnt how far you can comfortably manage without experiencing pain. Other activities you may find beneficial are cycling, gentle gym exercises or more complementary therapies such as yoga or pilates. See Physiotherapy and Exercise: Psoriatic Arthritis for more detail.

Balancing energy

• Try to keep back some energy for something you like to do; it will give you satisfaction and a morale boost
• Use pain relief regularly and as directed , as constant pain will make you fatigued
• Take regular, gentle exercise
• Take a rest before the children arrive home from school or if you are having visitors, as this will help you to spend more time with them
• Spread chores out over a few days rather than trying to complete them on the same day
• Stop any activity before you are too tired. Rest and then start again
• Plan your activities so that you can take time out to rest before and after
• Find time to relax by learning mindfulness or other similar relaxation techniques
• If you have been concentrating on a particular activity, you may find it helpful to follow it with some physical activity, change of scene and rest
• Sit down and use labour-saving devices when you can, as these will preserve your energy
• Be kind and gentle to yourself.

Keeping a diary

People find it difficult to understand why they feel fatigued; often there appears to be no obvious cause. You may find it useful to record the times and days you feel fatigued and for how long it lasts. Log the actions from the previous few days which might influence your energy levels, such as work, sleep, events, occasions, and even your food and drink. This may help you to understand the patterns and adjust your lifestyle and activities to reduce the incidence of fatigue. You will then be able to plan your life more effectively. It may also be useful to share this information with your healthcare provider, as they may be able to help you understand the causes.

Show and tell

Because not everyone fully understands the effects of fatigue, psoriasis or psoriatic arthritis, show family and friends a copy of this and other PAPAA information leaflets. You may find they can offer support and adjust activities and events to suit your needs.

If you are employed, it may be helpful to talk to your human resources department or your line manager, as they may be able to adjust your working environment. Under the Equality Act 2010 (Amendment) Regulations 2012, employers must make reasonable adjustments to make sure that workers with disabilities, such as physical or mental health conditions, are not substantially disadvantaged when doing their jobs. This applies to all workers, including trainees, apprentices, contract workers and business partners.

Conclusion

Although it is well recognised in many published scientific studies, that fatigue is a very common symptom in both psoriasis and psoriatic arthritis, it can be difficult to express exactly how it affects you. Most people with psoriasis and psoriatic arthritis who experience fatigue will find that it leaves them debilitated and affects their ability to function or carry out daily tasks, including work and studies. Even though there may be little interest from healthcare professionals in these symptoms you should persist and continue to report them as it is an indicator of what is going on in your body. Following some of the advice listed in this leaflet may not completely solve the fatigue that you experienced, but it will go a long way to help you cope, manage and deal with the symptoms that occur.

Show and tell

Because not everyone fully understands the effects of fatigue, psoriasis or psoriatic arthritis, show family and friends a copy of this and other PAPAA information leaflets. You may find they can offer support and adjust activities and events to suit your needs.

If you are employed, it may be helpful to talk to your human resources department or your line manager, as they may be able to adjust your working environment. Under the Equality Act 2010, employers must make reasonable adjustments to make sure workers with disabilities, physical or mental health conditions are not substantially disadvantaged when doing their jobs. This applies to all workers, including trainees, apprentices, contract workers and business partners.

Why not share your experiences

Conclusion

A number of published scientific studies suggest that fatigue is an integral part of psoriasis and psoriatic arthritis, although there appears to be little link between levels of fatigue and disease severity. Overall, it is often dismissed by doctors as trivial, but people find that it can be very debilitating and affect their ability to function or carry out daily tasks, including work and studies.

This article is adapted from Psoriatic fatigue: Why do I feel so tired? leaflet.

Download our Psoriatic fatigue: Why do I feel so tired? leaflet as a PDF

Always consult your doctor or healthcare provider.

What is psoriatic arthritis and why is it dangerous for Kazakhstanis

What is psoriatic arthritis and why is it dangerous for Kazakhstanis

Psoriatic arthritis, a disease that was previously considered one of the varieties of rheumatoid arthritis, affecting more mature people, now became relevant for young people. Doctors note that the disease began to manifest itself at the age of 25 to 55 years. Now psoriatic arthritis is considered as an independent pathology, which most often develops in patients with psoriasis, reports NUR.KZ.

Psoriatic arthritis can cause stiffness and swelling of joints, such as the feet and hands, and inflammation where the tendons attach to the bone, all accompanied by increased fatigue, pain, and limited movement. If left untreated, psoriatic arthritis can cause permanent joint damage.

Professor Bakhytsholpan Gabdulkhakimovna Isayeva told in an interview to NUR.KZ correspondent about the disease itself and its causes, as well as whether it is possible to get rid of psoriatic arthritis forever.

– Bakhytsholpan Gabdulkhakimovna, let’s define psoriatic arthritis.

— Psoriatic arthritis is a chronic inflammatory disease of the bones and joints. It belongs to the group of spondyloarthritis, it is also believed that this is a combined condition in psoriatic disease, approximately 30% of patients with psoriasis develop psoriatic arthritis.

Approximately 30% of patients with psoriasis develop psoriatic arthritis

The disease is accompanied by damage to many organs, develops in patients with psoriasis or in those who have a genetic predisposition to this skin disease. Psoriatic arthritis leads to functional disorders of the joints and a decrease in the quality of life.

The spread of the disease among the population is 2-3%, and among patients with psoriasis – in 6-42% of cases. At the same time, the gender of the patient in this case does not play any role, both men and women are equally affected by the disease.

— What are the main causes of the disease?

– Causes can be both external and internal. Among the external causes are injuries, infections, psycho-emotional overstrain and stress. At the same time, internal causes are predisposition to the development of psoriasis, psoriatic arthritis, disruption of the neuroendocrine and immune systems, obesity and smoking.

– How does psoriatic arthritis present?

– The disease manifests itself in the form of damage to the joints, tendons on the fingers and toes, inflammation in the places of attachment of the tendons to the bone, spine and sacroiliac joints.

At the same time, there is no relationship between arthritis and the severity of psoriasis, but in separate studies it is noted that arthritis is more common in patients with a larger area of ​​psoriasis on the body – more than 10% of the skin area.

— What symptoms should be paid attention to in order to identify the disease in time and contact a specialist?

– If a patient has a skin disease – psoriasis – and pains in the joints, heels, changes in the nails appear, then you should definitely consult a rheumatologist.

Diagnosing psoriatic arthritis is not difficult, but it is important to do it as early as possible

This is due to the fact that structural changes in bone tissue occur at an early stage, dysfunction of the joints. Other diseases can also join, for example, the cardiovascular system, liver dysfunction, diabetes mellitus, and cancer.

Psoriasis Epidemiology Screening Tool*

The PEST questionnaire is used for diagnosis, which includes 6 questions

1. Have you ever had swelling of the joints (one or more)?

2. Has a doctor ever told you that you have arthritis?

3. Have you ever noticed any changes on the nails of your fingers and toes, for example, in the form of dotted depressions, bumps?

4. Have you ever noticed pain in your heel?

5. Have you ever had uniformly swollen and painful fingers or toes for no apparent reason?

*https://medicinehealth.leeds.ac.uk/download/downloads/id/128/pest_russian.pdf

If the patient answers yes to 3 or more questions, it can be assumed that he may have and develop psoriatic arthritis . I note that for a consultation with psoriasis, you should contact a dermatologist, and for articular manifestations, a general practitioner at the place of residence, who, if psoriatic arthritis is suspected, will refer you to a rheumatologist for a consultation.

– How likely is psoriatic arthritis to become disabled?

— Psoriatic arthritis has a negative impact on the quality of life of patients and their social adaptation due to progressive lesions of the musculoskeletal system and skin.

Disability or disability is associated with the development of destructive changes in the joints and their functional insufficiency. The life expectancy of patients with this disease is lower by 5-7 years compared to people who do not suffer from this disease.

In addition, there is an increased risk of developing other diseases, such as diabetes, hypertension, coronary heart disease, obesity, depression, alcoholism, lymphoma, non-alcoholic liver disease.**

** https: //rsp.ima-press.net/rsp/article/viewFile/2011/1270.pdf

– What age patients are at risk?

– Psoriatic arthritis can develop at any age, but gradually. Rarely, when the disease has an acute course. In 70% of patients, skin lesions first appear, and only then – damage to the joints, spine or enthesis – places of attachment of tendons to the bone.

In 20% of these lesions appear simultaneously, in 15-20% of patients arthritis occurs before the first clinical manifestations of psoriasis.

In 20% of these lesions appear simultaneously

In 15–20% of patients arthritis occurs before the first clinical manifestations of psoriasis

— arthritis.

— Non-steroidal anti-inflammatory drugs are used to treat patients with psoriatic arthritis at the initial stage. If you have symptoms of arthritis, your doctor may prescribe systemic corticosteroids. They are injected into the joints.

For moderate to severe arthritis, so-called basic anti-inflammatory drugs are used, including innovative treatment.

Check every 3-6 months to see if the disease is in remission or in minimal activity.

It is also important to say that the treatment of psoriatic arthritis of all degrees of severity in Kazakhstan is provided free of charge under the OSMS.

Prepared with the support of Janssen,
Pharmaceutical division of the Branch of Johnson & Johnson LLC in Kazakhstan (СР-233714)

© “Internet portal Nur” LLP, 2009-2021
All rights reserved . Dr. Peter

• Directory of Diseases

September 26, 2022

Psoriatic arthritis is an inflammation of the joints that occurs as a result of psoriasis. It is characterized by soreness and stiffness of the joints, leading to constant fatigue and weakness in some people. Inflammation is usually the result of an autoimmune process. However, arthritis can also occur in people without visible skin changes.

Source:

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The condition can be very distressing, disturbing sleep and affecting family, work and daily activities. Various treatments can relieve symptoms and protect joints from damage.

Causes

In the case of psoriasis with inflamed joints, an autoimmune reaction takes place. The main cause of psoriatic arthritis is a condition where the immune system is overactive and releases more messenger substances (cytokines) that trigger various inflammatory responses. Genes play an important role in this: if parents, brother or sister are sick with any form of the disease, the risk of developing it increases greatly.

Approximately 25% of people with psoriasis eventually develop psoriatic arthritis. It usually occurs between the ages of 30 and 50. But it can happen at any age.

Approximately 80-90% of people develop the disease as a result of the initial cutaneous form, often many years later. However, joints can also become inflamed with or without visible skin changes.

There is no clear correlation between the severity of the course of the disease itself and the severity of psoriatic arthritis. Some people have severe skin psoriasis but no joint problems. Other people have arthritis but little or no skin changes. It is difficult to predict how psoriatic arthritis will progress. In some people, only a few joints become inflamed, while in others, over time, more of them become inflamed.

Symptoms of psoriatic arthritis

This disease can cause various symptoms. These include, first of all:

• Painful, aching joints.

• Joint stiffness, especially in the morning (stiffness often resolves within half an hour with exercise).

• Swelling of the joints, they are warm to the touch and sensitive to touch.

• Fatigue.

• Inflammation of the small intervertebral joints in the spine can cause back pain.

Psoriatic arthritis can affect many joints and vary in severity. The arms, legs, elbows, knees, neck, or vertebrae are often affected. It is not uncommon for more than five joints to become inflamed, including the terminal phalanges of the fingers and toes. The latter, in particular, can also be deformed as the disease progresses.

In addition to the joints, tendons and tendon sheaths sometimes become inflamed. Most people with psoriatic arthritis also have nail disease. Small indentations may form on the nail, which may thicken, discolor, and flake off. Nail lesions are difficult to treat and can be mistaken for nail fungus.

Possible complications and risks

If the inflammation is severe and the disease progresses, the joints can be permanently damaged and deformed. However, joint damage can be stopped or delayed by treatment with disease-modifying drugs.

Diagnosis

The following tests and tips can help identify psoriatic arthritis and distinguish it from other joint inflammations:

• Physical examination: certain changes are typical of psoriatic arthritis. For example, an entire finger (dactylitis) or tendons and tendon sheaths in the hands or feet (enthesitis), such as the Achilles tendon, may become inflamed.

• Family history: If psoriasis runs in the family, joint symptoms suggest possible arthritis.

• Blood tests: 90% of people with this condition do not have the antibodies that are commonly found in rheumatoid arthritis in their blood. If none of these so-called rheumatoid factors are found, psoriatic arthritis is more likely.

• Imaging: X-ray and ultrasound can help distinguish between psoriatic, rheumatoid, and osteoarthritis. The images can also be used to fully assess the type and extent of joint damage. However, they often cannot clearly show changes in the joints at the onset of pathology.

• Uric acid test: High levels of uric acid in the blood indicate that joint problems are not caused by psoriatic arthritis, but by gout.

An estimated 10% of people have no visible skin changes. In this case, it becomes more difficult to distinguish this disease from other joint diseases.

How to treat psoriatic arthritis

Treatment of psoriasis and arthritis in it has the following goals:

1. relieve symptoms such as pain and swelling

2. preserve joint function

3. prevent long-term joint damage.

People suffering from psoriatic arthritis can reduce inflammation, strengthen joints and prevent fatigue on their own. This includes getting enough exercise, not smoking, and losing weight if you are seriously overweight. However, the effectiveness of these measures has so far been largely unexplored in studies.

Medicines play an important role. If inflammation of the knees, elbows, or wrists is mild, treatment with NSAID painkillers is sometimes sufficient. These include, for example, diclofenac, ibuprofen and naproxen. These drugs can be taken as a tablet or applied to inflamed joints as a gel or cream.

If this is not enough or there are signs of an unfavorable course, treatment with basic drugs is recommended. These agents inhibit inflammation in the joints. As a result, they can not only relieve symptoms, but also prevent or delay tissue damage. Disease-modifying drugs include methotrexate, leflunomide, and so-called biologics.

Joint, muscle or tendon problems can also be treated with physiotherapy or occupational therapy and with orthotics such as insoles or orthoses.

Attention!

The information on this site is not a guide to self-medication. All materials are for reference only and do not replace a visit to the doctor. If any symptoms appear, you should contact a specialist.

Literature:

1. Alinaghi F, Calov M, Kristensen LE et al. Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies.